Terapia individualizzata della menopauza

Terapia individualizzata della menopauza

Individualise hormone replacement therapy Hormone replacement is an educated art : not one size suits all Pro and Cons: EBM The advantages and disadvantages of hormone replacement therapy (HRT) are well known.  Besides the treatment of symptoms, the prevention of wrinkles and bone loss and brain function, and the prevention of  cardiovascular accident, of bowel cancer and of the mortality of ovarian cancer and of breast cancer  are well documented.   HRT does not cause an increase in breast or ovarian cancers. The disadvantages are a minimal increase in the risk of deep vein thrombosis and of premenstrual tension in women who experienced this before menopause. In women with a uterus menstrual or irregular blood loss can be a problem. Notwithstanding these important advantages, are not that many women using hormones.  For us, the most important reason is the lack of individualization of hormone replacement therapy, which requires the right products in the right dose  with focus on the mental tonic effect and well-being. Brain effects and Well-being Estrogens,  progestagens and androgens have brain effects . That brain effects and well-being are the key drivers for the patient, is not recognized sufficiently by the gynecologist; Evidence based medicine is often considered as the evidence that a treatment is efficient and safe. Although the RCT is mathematically correct it is often forgotten that this is only true if the population investigated is homogeneous. We therefore know that  we have to be careful to extrapolate  the conclusions of a study to another country, race, population etc. However we are all individuals with differences. This is clear for height and color of hair, ...
vaso di pandora della therapia per endometriosi

vaso di pandora della therapia per endometriosi

Vaso di Pandora : la terapia dell'endometriosi Pandora’s box of endometriosis therapy Evidence based medicine Therapy in medicine should be based on evidence.  This is important to ascertain that a therapy is useful without side effects.  It protects the patient from practices without a proven benefit and reduces the cost of medicine. Evidence based medicine has developed a ranking of evidence known as the pyramid of evidence. This ranking is mathematically correct with the Randomised Controlled Trial on top. Randomisation avoid an allocation bias and ascertains that the 2 groups are identical. The limitations of a RCT A non blinded trial of pain therapy is not useful. The effect of a treatment should be evaluated without bias. This is obvious If the effect can be objectively measured as height or weight. For endpoints as pain or well being, there is the well know placebo effect and observer bias. RCT on pain and well being thus have to be double blinded to be valid. A RCT trial is not useful for complex multimorbidities. The results of a RCT are rue only for the group of women investigated and cannot be extrapolated. What can be a valid conclusion for 20 year old is not necessarily valid for a 60 year old. For this reason RCT are not suited for multi-morbidities. only Clinical observation can detect rare events. A RCT evaluates a group as a whole and cannot detect or exclude a (hidden) small subgroup with an opposite effect. Only after detection by clinical observation this can be evaluated by another RCT. The player Bias Treatment varies with the specialist in infertility...
Profssa Anastasia Ussia

Profssa Anastasia Ussia

News & Events   Profssa Ussia Anastasia Cari amici Ho il piacere di condividere con voi la mia soddisfazione e la mia emozione per aver ricevuto oggi a Mosca un importante ed ambito riconoscimento:il diploma di professore honoris causa per aver contribuito per oltre 25 anni di collaborazione allo sviluppo della medicina della riproduzione e alla diffusione della chirurgia laparoscopica in Russia.Ho dedicato la mia vita professionale allo studio dell’endometriosi e alla chirurgia laparoscopica della infertilità e delle patologie benigne ginecologiche ,non è stato facile ma oggi sono veramente felice di quello che ho realizzato in tutti questi anni!!Devo ringraziare soprattutto la professoressa Leila Adamyan della Università di Mosca per avermi dato la possibilità di crescere professionalmente e di confrontarmi con colleghi di tutto il mondo.In Mosca ho avuto la possibilità di conoscere i pionieri della chirurgia laparoscopica ginecologica quali il professor Harry Reich, il professor Philippe Koninckx , il professor Wattiez e tanti altri che per motivi di spazio non elenco tutti ma che ringrazio tutti dal profondo del cuore per l’esempio e l’insegnamento ricevuto. Anastasia...
ESMYA non è più utilizzato per mioma dal GIB

ESMYA non è più utilizzato per mioma dal GIB

ESMYA per MIOMA GIB non utilizza più Treatment of Myoma by GIB : suspension of ESMYA treatment Symptomatic  uterine myoma’s need  treatment.  Symptoms can be discomfort and/or pain especially when larger.  Submucous myoma’s can contribute to infertility. The etiology of most –if not all- myoma’s are genetic or epigenetic incidents to the myometrial cells, similar to the etiology of endometriosis. This explains  racial and hereditary differences in prevalence. It also suggest that similar to endometriosis myoma’s can be heterogeneous and that all myoma’s do not react in a similar manner to estrogens and progestogens.  Surgical treatment Being a benign tumour the primary treatment is surgery which can be Hysteroscopic myomectomy for intracavitary or submucous myoma’s.  We explain the possibilities and relative benefits of a 2 step surgery  when these myoma’s are bigger than 4-5 cm or intramural. This will permit a personal choice by the individual woman. Laparoscopic myomectomy . The relative benefits and possibilities of a laparoscopic myomectomy,  of eventually multiple myomectomies  and of a subtotal hysterectomy will be explained. This will permit women to take personal decisions after taking into account age, and fertility. Also for very large myoma’s  it will be discussed beforehand when we consider that a mini-laparotomy is preferable  to extensive laparoscopic suturing Also the risk and benefits of morcellation  and the risk of sarcoma spreading  are discussed  in order to permit individual choices. Medical treatment Until the recent introduction of ESMYA there was no effective medical treatment of myoma’s. Results have been promising especially for bleeding. ESMYA an antiprogestin.  Recently serious liver injury, including liver failure leading to transplantation was reported. Therefore the...
Qualità della chirurgia

Qualità della chirurgia

Qualità della chirurgia endometriosiisterectomia   Quality of surgery is variable In Belgium we are having a discussion on quality of surgery and cost for the patient. At the University hospital gasthuisberg, patients were informed that for private patiens the Professor would do the intervention himself; otherwise it would be done by a registrar in training. This has been widely considered unethical and socially unacceptable since equal quality for everybody is a dogma of Belgian medicine.  In a press release, the conclusion was that quality was the same for everybody since the registrars in training  were well supervised and since all gynecologist or surgeon are considered equal because of their diploma. Unfortunateoly this is  not true and the quality of diagnosis and of treatment can be very variable.  This is easy to illustrate for surgery and the examples given are restricted to comments made before during presentations or in publications. Quality is variable “We only recognize what we know ”. This is well known for the diagnosis of endometriosis. Even large and vaginally visible nodules are often missed during clinical exam. Even during surgery many severe deep endometriosis nodules of the sigmoid will be missed. ‘The best technique is the one the surgeon is familiar with  ”, is often heard at meetings . This is unacceptable.  If the superiority of a technique has been demonstrated, the surgeon should be obliged to use it.  The advantages of a laparoscopic treatment of an extra-uterine pregnancy in comparison with a laparotomy are well demonstrated. Yet so many women are still treated by laparotomy because the gynecologist on duty does not have the skills.“Do...

Shiny Trinket

Shiny trinkets are shiny.